Healthcare Provider Details

I. General information

NPI: 1710138862
Provider Name (Legal Business Name): LAURA ELEANOR NELSON LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 LEARY WAY NW
SEATTLE WA
98107-4535
US

IV. Provider business mailing address

1317 E FAIRBANKS ST
TACOMA WA
98404-3809
US

V. Phone/Fax

Practice location:
  • Phone: 206-854-6141
  • Fax:
Mailing address:
  • Phone: 206-854-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3888947
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60020048
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: